Letrozole - Fracture in spine

Cath62

Hi, a couple of weeks ago I posted about pain in my bones in my ribs and needing a bone scan. At the time the doctor was checking on bone mets. 

Well I don't have bone mets which is great but the bone scan revealed a fracture in T9 of my spine and osteoporosis. This is scary because I have not even injured myself. I do recall picking up my 15 month old grandson and feeling pain which prompted me to get more tests done. 

My ongoing treatment is Letrozole. I have only been on this for 6 months after switching from tamoxifen because of adverse side effects from that drug  

I had a bone density taken before I started tamoxifen in November of 2020 and it was perfect at that time. So in the last 2 years of treatment my bone density has taken a big hit. Spontaneous fractures are a bit of a worry. 

My GP gave me an injection today for the osteoporosis which I will now have every 6 months as well as taking vit D and caltrate with K2. I also made an appointment with my oncologist for Tuesday. 

Just wanted to see if fractures have happened to others on AIs?

Also a reminder to keep an eye on bone density. 

Afraser

Bad luck! I will finish ten years on Letrozole in May, and all going well, no fractures. I have had two accidents in that time which might have resulted in problems but all good. My bone density has declined, which is probably partly age but it was very good at the beginning so I hope will see me through. Two years seems a surprisingly short time for such a turnaround. I have been taking vitamin D and caltrate throughout and also as much weight bearing exercise as possible. Best wishes for the injections. 

jennyss

Dear @Cath62,
Good news and bad news - ain't that the way it goes!

Locksley

Hi Cath
Sorry you have a fracture.  You have reminded me I have a question to ask my medical team when I see them next about a bone dexa scan.  I thought it was something that I should have every year and I have only had 1.  

You have also reminded me I need to take my vit d and magnesium daily not just the days I remember too which is not a lot of them.!!

Hope the injection helps you.  

Keeping_positive1

So glad it isn't bone mets, but sorry about hearing you have a fracture.  I was told that if a person has osteoarthritis (particularly in the spine region) then a true reading/result is not as clear cut as we may think.  Mainly because if there are any bone spurs it will be more difficult to obtain an accurate test result.  I never had heard of this before, but was told at my last dexa scan which was only about 3 weeks ago.

Has anyone else heard of this before?  Wondering if the reason was you already had some osteoarthritis in your spine, and possibly already pre osteoporotic without tests revealing that.  It does indeed sound strange to be within range 2 years ago, and only so far 2 years on AIs to have your T9 of your spine become so brittle. 

@Cath62 were you given the Prolia injection?  

Afraser

My oncologist mentioned that arthritis can give an inaccurate reading (ie better than it really is) also in connection to the spine. First he’d mentioned it, after almost 10 years of tests! 

Keeping_positive1

@Afraser I was thinking I had a great reading in connection to my spine, whereas my pain the back is constant from the osteoarthritis.  Amazing we hadn't heard of this before, I was blissfully unaware and thought, well I have osteoarthritis in my spine but at least I don't have any osteoporosis in my back.  Not necessarily so. 

Afraser

I’m not sure exactly what it means. My oncologist too took the wind out of sails (there was I thinking my last reading was an improvement!) but I have absolutely no pain or discomfort, do yoga and can twist my spine with the best of them. I don’t have osteoporosis, my left hip has been the most osteopoenic part of me, so I don’t know. Maybe things will be clearer when I stop taking the AI. 

Keeping_positive1

@Afraser at the rate us forum members are going some of us are on our way to earning an honorary doctorate in the oncology field. 

Keeping_positive1

Oh yes, I must not have osteoporosis in the spine either, as still in the "green" area, but in my left hip I am osteopoenic as in the yellow area.  It doesn't state what the state of my right hip is in, not sure they scan both???  Do you know?

I also had an improvement and queried this a couple of years ago, and was told this can happen.  However last scan a few weeks ago I commented how great my spine result is and she jolted me back to reality!

Cath62

Yes @Keeping_positive1 I was given Prolia.  I am relieved to know what the pain is from. Just need to heal this fracture and keep taking the medicine 😀. Bloody nuisance. I will have a chat to the physio about some weight bearing exercises when I can and discuss with the oncologist. 

Abbydog

That is good and bad news.
I had Osteopenia, prior to cancer in 2020.
I am on AI's too.
My Oncologist has been monitoring my bone density annually, in anticipation of decreasing bone density.
I had my first Zometa infusion in December.
My drug has issues for me with Dental work.
Were you told of any side effects for the injection that you were given?
Our cancer treatments are the gifts that just keep giving.
But not each of us are exactly the same.

Afraser

My oncologist is a cautious soul, knows his stuff but not one for leaping on every good sign without analysing it! As far as I know, the bone density scan can check anything requested, mine seems to check both best and worst areas and a bit in between! Given I am so close to finishing my AI treatment, I’m avoiding Prolia. But I am also well aware that not getting any worse may be the best I can anticipate. Which would be fine. 

Cath62

Hi @Abbydog, yes potentially there could be side effects like muscle and joint pain. The jaw bone could be impacted too so dental hygiene is important. I guess like all medications there are side effects and don't we know it. I felt so good when I changed from tamoxifen to Letrozole nut inside my bone density has really taken a hit and I never thought I would be sitting here now with a spinal fracture at 60.

 I guess in discussion with my doctor I agreed that having a fracture in my spine is a serious thing especially given I didn't have any trauma to get it. The worse I did was pick up my 15 month old grandson. I have to have these injections now because the risk of my fractures for me given my results of my bone scan are higher than the chance of the side effects from the injection. 

iserbrown

@Cath62
At least now you know.  Similar for my sister but for her it's the long term use of steroids, needed to keep airways open.  Unexpected side effects!

Take care

Keeping_positive1

@Cath62 it would have been a shock considering it was just caused by lifting your grandson.  But as @iserbrown says at least you now know.  Now you can stop the bones from deteriorating more by having the prolio injection.  I do weight bearing exercises and resistance exercises and I feel they keep me stronger.  I also do some falls prevention exercises at home.  COTA (Council of the Ageing) have also some really good online exercises you can do, and also they can direct you to the Living Longer, Living Stronger classes that are run in different locations.  Of course your physio will have some programs also.  Another program that springs to mind is the GLAD program (Good Living Arthritis Denmark) and the program runs for 6 weeks, twice a week.  That can be expensive, but I was able to go through that after a 2 year wait in the public system, but in the meantime I did some of those exercises through watching online.

I hope you heal well from your fracture, and the pain is easing for you.  All the best with your treatment.